Afghanistan may bear the highest COVID-19 toll if ignored by the world…

3935

War affected Afghanistan is estimated to have a total population of 37 million. The majority of the population is illiterate, over 50% live below the poverty rate and, according to the latest UN appeal for the country, 9.4 million people are considered in dire need of immediate humanitarian assistance, Weak governance and corruption continue to characterize the country’s political system – the 2019 Corruption Perception Index listed Afghanistan as among the most corrupted countries worldwide, scoring16th, between Sudan and North Korea. A chronically weak health system and lack of health insurance, coupled with the current political tensions between Dr. Ashraf Ghani and Dr. Abdullah Abdullah due to elections fraud, means that Afghanistan’s ability to manage and response to the COVID-19 outbreak is strained at best, impossible at worse.

To date, the consequences of the outbreak are only just beginning to emerge. With only one test center in Kabul and the number of positive cases reaching 840, of which 20% is said to be of medical professionals, there is a strong indication that the pandemic is penetrating fast and the country is woefully ill-equipped to address it. Lacking test centers and the necessary professional health capacity to identify and manage positive cases of the COVID-19, measures to prevent further spread and mitigate risks to the wider population are limited.

Afghanistan’s population is one that traditionally has high levels of mobility – with huge numbers of cross border movements with its neighbor Iran, previously an epicenter for the COVID-19 outbreak in the region. Iran is hosting upwards of two million Afghan refugees that are undocumented and, until April 2nd when the Iranian Government clarified that all ‘foreigners’ could access health services, were not able to access treatment. Prior to this date it is known that upwards of 75,000 Afghans streamed back across the border into Afghanistan. In recent days, a mass return of Afghans from the Eastern border with Pakistan has been seen, with over 10,000 rushing across the border after the Pakistani Government temporarily lifted the border closure.

With no quarantine policy and or facilities in place on the borders shared with the two neighboring countries, there is of course a high likelihood that many of the Afghans returning are now spreading COVID-19 within their communities to which they returned.

Over the past four decades, with conflict continuing in Afghanistan unabated, it is estimated that over 6 million Afghans fled to neighboring countries. Today, there remains a sizable protracted long-term refugee population in both Iran and Pakistan. With the majority of the population on the move due to war, insecurity and natural disasters, Afghanistan is now one of the world’s major contributors to the numbers of Internally Displaced Persons (IDPs). Conflict-induced displacement has been increasing exponentially year after year with the total IDPs reaching 3 million at the end of 2019. This includes 400,000 newly displaced just in 2019 that are mostly from previously safe parts of the country. IDPs live in limbo – unable to return or to find safe and secure local accommodation arrangements and mostly live in groups under tents and share single sources of water. Social distancing to protect them from COVID-19 is just simply not possible for IDPs. IDPs across Afghanistan tend to be the most vulnerable population for years remaining largely dependent on emergency shelter, water, education and health care and face multiple protection challenges. Yet the level of needs still far outweighs the available support. The Norwegian Refugee Council has reported on the growing use of negative coping mechanisms applied by IDP families due to the lack of support – such as the taking on of debt, child labor and early marriage – a practice which sees IDP families selling their children for financial support.

The unfortunate backdrop to a growing Covid-19 crisis in Afghanistan is a country ill-prepared or equipped to respond to likely response needs. This will be especially exacerbated for vulnerable groups like IDPs, owing to a set of intractable and interlinked political and economic problems, like a perfect storm, to which we now turn to:

Political Situation

The heavily promoted and controversial potential peace agreement between United States and Taliban to find a political settlement for the long-lasting war and break the stalemate in Afghanistan is seemingly failing at the first hurdle due to the growing political tensions that exist at the heart of the Afghan Government. The delay in release of prisoners by Dr. Ghani now- that was not explicitly opposed by the leaders of the National Unity Government in 2019 – is impeding intra-Afghan dialogue and delaying the U.S. forces withdrawal. Though the Taliban spring campaign is seemingly starting later this year, there has already been a steady increase in the level of fighting, with the Afghan Army and police suffering many casualties. This has only served to encourage some other small armed groups to resurge and vie for attention as peace talks prolong. Civilians continue to bear the brunt of this pro and anti-government fighting. Only in 2019, UNAMA reported some 10,392 civilian casualties (3,403 deaths and 6,989 injured) directly caused by the conflict– with over 40 percentage of them women and children.

With political tensions running high in Kabul due to claims of election fraud by Dr. Abdullah Abdullah, it now seems increasingly unlikely that further meaningful traction can take place with the nascent peace talks. This serious blockage for the peace talks will similarly stall and set-back government efforts to fight COVID-19, given how preoccupied the heart of Government is with the post-election fall out. The announcement of elections results by the Independent Election Commission after a five months delay resulted in a parallel oath-taking ceremony by the contesting candidates Dr. Ashraf Ghani and Dr. Abdullah Abdullah, signs of how fragile the political unity is presently in Kabul. The international community has been working with both camps to agree on establishing an inclusive government and avoid exacerbating an already tense situation across the country and the population’s grave concern over another possible civil war amid growing ethnic tensions.

As an example of such efforts, the U.S. State Secretary, Pompeo, traveled to Afghanistan on March 23rd– at very difficult time during which limited travel was taking place– to encourage a deal, but unsuccessfully. As a consequence, the US government decided to cut one billion dollars in aid and has signaled there may be further cuts coming , if an inclusive government is not agreed upon by the two rivals.

Economic Environment

Afghanistan remains one of the least developed countries in the world. A landlocked country with its economy dependent on foreign aid, the country has an unemployment rate of 23%, and 54% of the population live below the poverty line. In the 2019 Human Development Index, Afghanistan ranked 170 of 189 countries, listed as low HDI value of 0.496 and life expectancy of 64.5. Afghanistan’s gross national income (GNI) of per capital is $1,746. Afghanistan imported last year over $6 billion in goods and exported less than $1 billion – placing the country high on the list of countries that is largely dependent on its neighbors and other countries in terms of its meeting the needs of its people and their access to food and other goods.

Afghanistan’s first victim of COVID-19 was a person with no travel history out of the country, who died on March 22nd in Balkh province. His test result was delivered on the 24th – two days after he passed away. As of April 16th, Afghanistan’s ministry of public health reported 840 possible COVID-19 cases sent to medical laboratories. By then there were 30 dead and 50 recovered in 32 provinces, including the neighboring province to Iran, Herat, which recorded the highest number of cases and second Kabul. Afghanistan is seen by public health observers to be highly vulnerable, and the cases and death rate are widely predicted to be much higher than is reported by the government due to low testing capacity and shortage of medical equipment. These numbers also exclude people who are losing their lives with COVID-19 symptoms before actually getting tested or being admitted to the hospital. The demand for testing is getting progressively higher in high risk areas such as Herat and Kabul, but the lack of professional and technical capacity to test and respond is undoubtedly letting the virus spread and cases grow exponentially. Sadly, as tends to be the case, the most vulnerable are those thought to be most at risk at least able to get tested and treated – including displaced people, and particularly pregnant women, those with disabilities and elderly people.

The Afghan government established COVID 19 emergency response committee led by the Director of Public and Strategic Affairs at the Presidential Palace – a man who has no medical background nor seemingly any crisis management experience. His early decision to delay a quarantine plan for Herat despite the Ministry of Health’s repeated advice and also the ill-advised choice to spend $380,000 on expensive yet largely irrelevant print materials for awareness purposes has caused public outcry in social media – with many Afghans calling on the government to appoint a professional and experienced person to lead the committee. The government has subsequently closed schools and universities and restricted public gatherings, and followed-through with complete movement lockdowns in Herat and Kabul. Measures which now look like too little, too late.

The COVID-19 Multi-Sector Humanitarian Country Plan for Afghanistan was officially launched on March 25 and requested $108.1 million for three months to compliment health response to COVID-19 and reach 6.1 million people in provinces at risk and focusing on emergency humanitarian efforts.

Many international humanitarian aid agencies are struggling with the situation and found it necessary to evacuate most of their international staff out of the country, and in some cases only allowing their national staff work from home until further notice. In light of the current situation of total lockdown and with key workers quarantined at homes with no income and no plan by the government to distribute food items, people urgently need assistance from the international aid agencies. Their presence is needed more than ever.

The situation in the areas controlled by the Taliban is even worse. Taliban spokesperson Suhail Shaheen tweeted on March 16: “The Islamic Emirates via its Health Commission assures all International health organizations and WHO of its readiness to cooperate and coordinate with them in combatting the Corona virus”. Social media was is alight with pictures of Taliban fighters being armed and currying guns with personal protection equipment, preparing to respond COVID-19 in Kunduz, a Taliban stronghold province in North Western Afghanistan.

As the government announced new desperate requests for people to stay home, the price of food was doubled owing to high levels of panic buying as people decided to buy more and prepare for the worse days. Ajmal, whose household is in Kabul, said “the price of food is so high, and I am not able to buy food for my family. The government can’t control the market and people may die of hunger if the quarantine prolongs.”

He added that “the average persons’ income is not enough in normal times to buy enough food for an average size Afghan family”, which is 8 people.

Kabul has a population of 7 million and large numbers of households depend on low daily income. Many are struggling to have enough food and are now doubly impacted due to the loss of their income under the newly imposed quarantine restrictions. Farhad Hashimi, a young leader in Kabul province initiated a way of helping vulnerable households and individuals who are not able to buy food and support family during the breakout. He called some wealthy Afghans and businesses to help him gather charity and prepared packages of food. These packets include 49 KG flour, 25 KG rice, 5 KG oil with some tea and salt. They are distributed to more than 341 war widow’s families. Each package costs $60 and is estimated to suffice a family’s need for a month. Such acts of charity are essential in Afghanistan during the Covid-19 outbreak owing to the limited help the state is able to offer.

Hashimi suggests localized responses to help poor people and encourage wealthy Afghans to pay Zakat to the most vulnerable people. He is planning to run a campaign to encourage those who were planning to attend pilgrimage but cannot do so due to the COVID-19 outbreak to buy food packages for widows and orphans. He explains that “every year some 30,000 Afghanistan citizens would attend pilgrimage that costed attendees around $90 million, with each person spending at least $3000. If this campaign succeeds, around two million widows’ families can have food for a month.”

But, Hashimi is still uncertain whether or not this campaign alone will meet the growing levels of need. He adds that “people fear hunger and already feel overcome by it; they yet don’t know what COVID-19 is.”

Hashimi emphasizes that a humanitarian crisis will emerge if the international community does not act immediately. He suggests that the political tensions and corruption will derail any aid support provided directly to the Government. So, he suggests that the international aid agencies use the Community Development Councils (CDCs) as the main mechanism to distribute food packages to people in need all of Afghanistan. CDC is a local delivery mechanism that has been working as an alternative village level mechanism to identify development needs and implement development projects.

Other Afghan youth groups are volunteering to distribute masks and gloves for people in the streets of Kabul, helping to play an important role in this critical time and ensure the safety of the people. Some Afghan businessmen in major cities such as Kabul, Herat, and Balkh provinces offered their private houses for use as hospitals for COVID-19 affected people. These are encouraging signs of solidarity and fulfillment of social responsibility.

Worryingly, Afghanistan culture has a high regard for funeral and wedding ceremonies. A large gathering can be expected at funerals including hundreds of relatives and neighbors. Those gathering to honor COVID-19 victims could quickly multiply the number of infected people, growing the problem beyond the resources of the fragile state.

Sadiq Hotak, an educated young Afghan who lives in Kabul said “Afghanistan lacks the health-care system and public-service infrastructure required to deal with an infection and Afghanistan is among the countries most vulnerable to the Coronavirus pandemic.”

He added, “in the absence of a proper public-health system, a reduction in violence and effective political leadership, the Coronavirus outbreak could end up with a very heavy price.”

Because of the ongoing uncertainty in Afghanistan and the worldwide challenge of responding to COVID-19, coupled with conflict persisting in other contexts such as Syria, Yemen and Iraq, Afghanistan is not presently a top priority for international stakeholders. This includes development and humanitarian funding institutions. Therefore, there is every risk that Afghanistan is about to become a forgotten crisis once more.

On April 16, 2020 the New Afghan Generation’s Movement for Change sent an open letter to all parties of conflict requesting a humanitarian ceasefire that will allow aid agencies to provide services for vulnerable people in Afghanistan.

We urge the world not to forget Afghanistan.

Suggestions:

1. All parties of the conflict should agree to a Humanitarian Ceasefire in the country and help aid agencies to provide health services for people in need to save lives and avoid human disaster.

2. Expanding the test capacity in high risk areas where they have high number of positive cases registered.

3. Afghan government, aid agencies and people should increase context-oriented public awareness sessions on safety and risks of COVID-19

4. Distribute soap and food for highly vulnerable communities such as IDPs.

5. Localize response and include CDCs that are under Citizen Charter Program, one of the national priority programs.

6. Decentralize the COVID-19 response and allow each province to decide based on the situation and response best for the people at risks.

7. Aid agencies should ensure safe operations but continue to help people in need, distributing assistance and doing advocacy with donor countries to increase funding for Afghanistan.

8. Distribute food to people so they stay home and follow the direction from the government side to prevent spread of COVID-19.

9. The Afghan government should allocate more of the budget to high risk provinces.

10. Donor countries should help Afghanistan to fight COVID-19 and fully fund the Covid-19 Emergency Appeal.

Sources:

Afghanistan COVID-19 Multi Sector Humanitarian Country Plan https://www.humanitarianresponse.info/en/operations/afghanistan/document/afghanistan-covid-19-multi-sector-humanitarian-country-plan

Transparency International, The 2019 Corruption Perceptions Index, https://www.transparency.org/cpi2019

UNDP Human Development Report (2019) http://hdr.undp.org/en/content/human-development-report-2019

Humanitarian needs overview 2020 https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/afg_humanitarian_needs_overview_2020.pdf

UNAMA, Afghanistan Protection of civilians annual in armed conflict 2019 https://unama.unmissions.org/sites/default/files/executive_summary_-_afghanistan_protection_of_civilians_annual_report_2019_english.pdf

IOM, return of undocumented Afghans https://afghanistan.iom.int/sites/default/files/Reports/iom_afghanistan-return_of_undocumented_afghans-_situation_report_08-14_march_2020.pdf

Afghanistan Central Statistics Organization, Afghanistan Living Conditions Survey, 2016/17 https://washdata.org/sites/default/files/documents/reports/2018-07/Afghanistan%20ALCS%202016-17%20Analysis%20report.pdf

Asia Foundation, Afghanistan in 2019 – a survey of the Afghan people, November 2019, https://asiafoundation.org/where-we-work/afghanistan/survey/

International Organization for Migration (IOM) Displacement Tracking Matrix (DTM), unpublished cross-analysis of Baseline Mobility Assessment Summary Results, Round 8, Mar – Jun 2019 data (IOM, Afghanistan, 2019) and health facilities data (WHO, Kabul, 20 May 2019)
World bank, https://data.worldbank.org/country/afghanistan

The observatory of economic complexity https://oec.world/en/profile/country/afg/

Afghanistan Ministry of Public Health, https://moph.gov.af/en

Previous articleThe Role of Yemeni Women in Aden Through the Lens of WPS: is this the Right Time?
Next articleCombatting Trafficking in Persons (CTIP): A Conundrum for Contractors
Said Ebad Hashimi
Said Ebad Hashemi is originally from Afghanistan and has 12 years of working experience with international NGOs and the U.S. Government, and holds a master’s degree in International Relations. He spent 5 years working with PRM in Afghanistan, managing and monitoring activities on education, protection, and livelihoods sectors during which time he has become highly skilled in Advocacy and Humanitarian Diplomacy. Throughout his career he has collaborated with numerous non-governmental organizations, the Afghan government, the U.S. Mission, United Nations offices and other diplomatic missions for managing multi-sectoral USG-funded activities in Afghanistan. Said Ebad is a strong networker and influencer, he has knowledge of key international institutions and policies relating to humanitarian issues including debates surrounding protection in emergencies, humanitarian reform, humanitarian principles and complex emergencies.